Healthcare Provider Details

I. General information

NPI: 1558141176
Provider Name (Legal Business Name): KIRSTEN ALYSSA GIBBS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 JACKSON AVE
POINT PLEASANT WV
25550-1615
US

IV. Provider business mailing address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4498
  • Fax:
Mailing address:
  • Phone: 740-446-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: